Outline:
Medication Relatedness Determinations and Hospice Formularies: Understanding the Essentials

Objectives

CMS Regulations regarding Medication Coverage

FY 2016 “Final Rule”

Payment Responsibility for Non-Beneficial Medications

Payment Responsibility for Non-Formulary Medications

Four Buckets of Medication “Relatedness”

Medications Always Covered

Drugs Never Covered by Part D or Hospice

Examples of Medications Usually Not Covered

Examples of Non-Palliative Drugs: Consider Discontinuing

Common Formulary Alternatives

Relatedness: Admission Nurse’s Role

Relatedness: Medical Director’s Role

Relatedness: IDG Role

Determination of Hospice Medication Coverage

Step 1

Step 2

Step 3

Step 4

Step 5

Step 6

Step 7

More Documentation Examples

Documenting Related, But Not Covered

Step 8

Case Example: Mrs. G.

Assessing Terminal Prognosis

Related Co-Morbidities

Related Secondary Conditions

Determining Relatedness

Mrs. G’s Med Profile

Four Buckets of Medication “Relatedness”

Medication Review Summary

Summary of Coverage Responsibility

Best Practices

Resources and Links

Contact Information

Terri Maxwell, PhD, APRN, is Chief Clinical Officer of Turn-Key Health, a division of Enclara Pharmacia. A frequent presenter at state and national meetings, Terri is a well-published author on a range of palliative care topics.  She obtained her BSN from the University of Rhode Island and a Masters Degree and PhD in Nursing from the University of Pennsylvania. Disclosure: Terri Maxwell, PhD, APRN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.